Restoring Health: The Crusoe Report 1

The diplomatic thing would be to say there is some agreement between the Witty Report and this one. There is certainly some overlap in suggested solutions.

We could perhaps even agree that the real problem is the failure of medicine rather than pharma malfeasance. But the fault-line runs deeper.

There are two or maybe three forces, depending on the way you look at it, that have created the whirlpool into which we are now being sucked. One set of forces lies in the push to consumption and the other lies in the nature of modern medicines.

A patch of ground

Lots of us used to have a small patch of ground where we grew vegetables or herbs – or maybe just flowers. Some of us still do. We produce our own food rather than buy it. Not so long ago most of us used to produce food or at least ate food produced by people we knew or were not far removed from.

Until very recently, after we bought food, we produced our own meals and usually did so for families or for a few people at the same time. Now when we buy food it’s often in the form of processed meals where all you need to do is hit a button on the microwave. There is no production. It’s all consumption. We might once have produced the fire that cooked our food, it’s now bought in in the form of a microwave.

Producing meals did more than provide food. It helped produce children and families and communities. Now the children will often come in from school to an empty house and press a button on the microwave. Who knows what’s in the meals. It might look like food but the food processing industry is increasingly getting away from anything that would have been recognized as food a few years ago. And eating meals this way is not producing a community.

Consuming convenience foods isn’t all bad. If you’re Beethoven absorbed in producing The Ode to Joy, being able to hit a button on the microwave might be a blessing – provided when you go to the supermarket to pick up something you’re not paralyzed trying to pick between exotic looking food packages that promise so much to the eyes but which you know will break their promises to your hope when you dig a fork into them.

Choice is one of the problems that consumption brings with it.

Annemarie Mol brings this out dramatically in The Logic of Care – one of the greatest books ever written about medicine.

I am pregnant and 36. A national committee of experts in the Netherlands where I live, has looked at the statistics and suggested that pregnant women over 35 should have an amniocentesis in case of Down’s Syndrome… I follow the advice. I take a day off and go to the hospital… I lie down on the examination table and feel the ultrasound probe moving over my belly. Still in my field work habits, or just to break the silence, I say to the nurse who is preparing the long needle that will be inserted into my womb: ‘I hope it all goes okay.’ We both know that a small percentage of women have a spontaneous abortion as a result of the procedure. The nurse snaps back: ‘Well, it is your own choice.’

This is no longer a system in which people are working together to produce health. This is an industry with products available for consumption or not. It has extraordinarily sophisticated ways to persuade your doctor to consume its products by putting them in your mouth. Often close to forcing you to take them, most of which you don’t need.

Infertile

Very few of us can justify consuming Fast Foods by appealing to the symphony we are working on. Most of us consume our burger while consuming the latest Infotainment from systems that make information and entertainment. While the world may now have become a Village – just like food, the Village News is divorced from the connections that villages and food once had. Its global gossip.

Even the so-called scientific articles about the drugs you might consume are infotainment divorced from the things that actually happened when a drug was given in a controlled trial. The articles are almost always written by a ghost-writer who has never prescribed a drug in her life.

There is a balance we all need to find between producing and consuming. If part of our time is spent working for someone else who is producing stuff for others to consume and the rest of our time is spent consuming yet other stuff, without us actually producing anything, we end up infertile – alienated, men would say – and probably unhealthy or at greater risk of becoming unhealthy.

Recipe

For millennia, the production of food and health were entwined. The Rx symbol for a prescription is an abbreviation of Recipe. The implication of the saying that it takes a Village to produce a Child is that the child is healthy. The knowledge of how to bring up children, ward off infections, alleviate problems using certain foods or herbs has been something passed down in families and communities. The pharmaceutical industry knows all about this. Trying to market ADHD, they found that the greatest barrier to getting treatment accepted was the presence of a grandmother who might caution against the child being treated because he’s just the same as his father was and look her son has turned out just fine.

The Village we live in now is not one in which one woman will tell another who has just been told that the bone scanner shows some bone thinning that getting out and running or working the garden is the best way to avoid fractures. It is a Village in which women will be pressured through fear to take bisphosphonates – among the most horrific drugs ever pushed – and will end up living greatly restricted and non-productive lives as a result.

Slow medicine

Back in the 1950s pharmaceutical companies participated in the production of health. New antibiotics saved lives and got people off sick beds and back to work. This was a health that made us wealthier. It made sense for nations to think about providing treatments like this for free.

But now companies produce medical goods for consumption. These come tagged as health-giving. But where once you took the risk that went with drugs when you were in crisis, now your healthcare provider likely summons you in for checks and puts you on treatments you didn’t ask for. Where once the norm was a short course of a treatment like an antibiotic until you were well and except in the case of insulin it was extraordinarily rare to be on a treatment for life, now it’s unusual to find people not on anything and very unusual to find anyone over 50 not on several drugs for the rest of their lives. We are harming ourselves to make drug companies healthy, and even the United States is working as hard as it can to make sure that as many people as possible get as much access to drugs as possible.

How did we get to this point?

For anyone who thinks the only way to fight the alienating forces of the modern world is to join ISIS or some other fundamentalist movement or to drop out of the Euro, the food domain shows that it is possible to fight back against “a sterile modernity”. Fast Foods don’t have it all their own way. The Slow Food movement – a movement that began in Southern Europe – looks like its here to stay. We need to building a Slow Medicine movement.

To be continued.

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Hi Irene, totally agree………. after 8 years on effexor, and finally trying to quite the crap that has destroyed my life……. Well I have still a 17 year old…. but I am mentally stuffed………. His brothers and sisters, I cooked, I gave them fruit after school, I cooked cakes and biscuits, and cooked roasts, and all home grown meals, but after effexor, I am incapable of doing any of this… yes effexor and antidepressants destroy us, destroy our enthusiasm, our love of family, our love of cooking, our love of cleaning and staying clean ourselves…….. destroyed my love of knitting sewing, everything… it destroyed my soul……….. good marketing now have Merck got something going with Monsatan? One makes us nuts, the other one sells us garbage food, but as nutters, we dont care…………………..

Last night’s unexpected merger between Pfizer and McDonald’s
sent shock waves through Wall Street,
the Pharmaceutical industry
and the heavily-processed meat community.

“It was a no-brainer, really” remarked Pfizer CEO Ian Read.

‘These beloved brands have long enjoyed a symbiotic corporate relationship.
We finally decided that as long as
McDonald’s is creating new patients for our medications
– medications which keep their consumers alive
and able to keep walking back to enjoy
those 99-cent specials – why not work together?’

The top-secret negotiations, months in the making,
sent stock prices soaring as McDonald’s franchises unveiled
a new “McHealth Menu”
that reflects the revised business model
of McDonald’s/Pfizer
(now listed as ‘McPfiz’ on the S&P 500).

‘It’s a logical progression
– together we’ll give people
the tasty food products they love,
and,
should said products threaten their health,
we also provide the drugs to neutralize that threat.”

New meals include
the Angus Chipotle Zithromax BBQ Burger,
which provides powerful antibiotics to combat fungal infection,
in addition to the undetermined antibiotics
injected during a cow’s short life before slaughter.

At a franchise in Bullwhallop, Texas,
hungry diner Sue Gompfolker opted for
the Premium Crispy Chicken McLyrica Classic.
“I’ve got a generalized anxiety disorder,
and this allows me to get the anticonvulsant I need,
with the bacon I crave.”

“It’s the circle of life” remarked McDonald’s VP Golgoth.
“Pfizer had the vision to partner with the largest fast-food chain in the world.”

When reminded that Subway recently surpassed McDonald’s
as the largest chain, Golgoth replied
“Yes, but we’ve still got the largest customers.”

Subway is rumored to be in talks with Merck.
The newly merged company has already secured preliminary approval
from Health and Human Services for Medicare
and Medicaid to cover the cost of McDonald’s Health Menu meals.
A small co-pay
may be required where brand-name drugs are used,
or HHS deems
the health-threat of McIngredients to be abnormally high.

Absolutely brilliant, thought I could write, but never as brilliantly as this article…. I am the grandmother, having the conversation with daughter, to save her two girls from gardasil………. I am the grandmother, who has seen grandchildren now with autism….. I am the grandmother, who lived through this scientific era, where the doctors honestly thought they were helping, despite the HIV and other stuff in the vaccines, and I am the grandmother who has seen the explosion of äpparently necessary”vaccinatioons for such things as chicken pox……… if you dont, you dont get your paid taxes (Austrtalia) partly paid back to you…. called Parenting Payment…… the control is disgusting………
……….. NOW? Medicine is about pushing untrialled anything, for profit, and greed……… my advice? Avoid doctors. avoid vaccines. avoid gmos………. ?????? look today, I tried to buy a microwave oven, that would last more than 12 months, they dont exist anymore, a throw away society……….. my first microwave? 20 damn years………….. I can not buy anything good, healthy, that works anymore……….. I can not buy good healthy tomatoes, nor non gmo corn chips………..But damn I hope my grandkids have a life longer than that……….. longer than the throwaway society, where it is expected they will have cancer or asthma, or diabetes, before 12 years old………. Then if they survive, gardasil? Get real, I am a grandmother.

Amnioscentisis? Dont do it…. I had one, because they said I needed it, I didn’t. Just caused me stress. When you have a child, you accept it, whatever that child is…… Dont stress, you will love that child……….
My daughter? Apparently the ultrasound came back that her daughter would never ever be able to walk, feed herself, due to a problem, this child would forever be disabled, and in nappies..
… My daughter was strong, she refused, all the pressure to abort……….. Her daughter, the apparently severly disabled one???? Annie, is gorgeous, Annie is now top of her class in grade 4…… yes I think it runs in the family, takes longer for that bit to grow, the bit that joins our brain to our spine…………. God bless my daughter, for resisting the pressure, god I thank her strength,,,,,,,,, Anysia is gorgeous happy, bright and clever, top of her class! She is now a gorgeous nearly teenager, and damn I had the conversation with my daughter, no to gardasil, I am relieved.
So my advice, forget the crap, go with your heart. Now my daughter, this support group for the children aborted due to this “problem” she can not bring herself to write, and say “sorry Annie is fine”.

Excellent post.
Freedom of choice and informed choice should go hand in hand. If they don’t then yes you are free to choose but what are you choosing if you don’t have the full picture. That’s not choice it’s just an impression of choice. So that the the consumer feels in control while they are being railroaded into something they don’t need or even want. It’s clever salesmanship. Most people will buck at the idea of being forced into something so if they believe it’s their choice they are more likely to do it. Then if it goes wrong the salesman can hold his hands up and say ‘ well you did have a choice, nobody forced you’.

We have become monster consumers. A couple of choices of this or that is no longer good enough. We have so many options to choose from its mind boggling. Even the phone call you make to complain about the choice you made which turned out to be the wrong choice takes an age because of all the automated options you need to choose from.

We think choice equals freedom, to a major extent it does because where would we be without freedom of choice ? But it also hinders us because there can be too much of a good thing.
Sometimes we make a choice just because we can even if we don’t necessarily need it. It’s there, it’s available for me to choose so why not have it? But is that choice or is it just consumer greed.

Is having the latest drugs because they are available and MAY prevent you from developing a condition that you may not get anyway a necessity, a choice or a way for Pharma to make huge profits ?
A terminally ill patient given the choice of a drug that may cure them or may do nothing or may harm them with what they are facing anyway would most probably think the benefits, the chance of a cure outweighs the risks. If I was in that position I would.
But what about the diabetic, whose cholesterol is slightly over and may or may not have slightly increased risk of a heart attack. Well lucky them because they have the choice of statins… except it’s not really a choice because the average patient won’t know the in ands outs of this drug. That’s the catch it’s not choice if it’s not informed. It becomes trusting belief in a medical professional who is second guessing on something that may never happen that is not choice. You trust the Doctor, so if the Doctor is offering you this get out of a heart attack deal then surely you have to take it. If you don’t you’ll only have yourself to blame when you drop down dead of a heart attack.

As I have said before I am not anti meds. No way, I had to have total thyroidectomy so my morning meds are absolutely essential. I also accept that for the benefits there are some risks. I have recently after being on a stable dose for 3 years become over medicated. So for the last few weeks have been experiencing the very unpleasant effects of being hyperthyroid. I accept though that this is something that may happen from time to time because my body can longer produce the hormone I need so I have to have a synthetic regular dose that may need adjustments. My benefits of this drug outweigh the risks because without it I would go into a coma and die.
If myself or any of my family needed medications I would want us to have that option but with informed choice and if we needed them not because we made an uninformed choice that we didn’t really need to make in the first place.
I’ll end this by telling you the words of wisdom of my 9 year old son who has Aspergers. We gave him several choices for a day out. After much discussion and debate he exploded into tears and said ” I don’t like choices, whatever I choose I know it will be the wrong one. There’s too many to choose from and it makes me upset. We are just wasting time choosing.”
Sometimes choice becomes a chore.

As to what has changed in the world of health care … it seems to me as if the drug companies have always tried to distort medicine in order to sell their products, even in the “good old days.” However, maybe they had a whole lot less social and economic power, and so didn’t get away with it as much?

Certainly in the 19th century they pushed all manner of marginally effective & dangerous products, from mercury to proprietary potions that were mainly opium or alcohol. Most of them were “constitutionals” too — stuff you were encouraged to take every day to stay strong and healthy, as opposed to remedies that should stay on the shelf until someone got sick.

While they did develop the antibiotics, etc. in the 20th century they also developed and vastly over-promoted opium tinctures and barbiturates. Not to mention tons of amphetamines, for everything from depression to excess weight to female “change of life.” However it seems as if there was at least a bit of stigma attached to doing research that was directly sponsored by the drug industry. And in terms of physician acceptance of their pitches, there was a wide variety.

So when did their clout reach that critical mass where they could put their stamp on the entire “health” agenda?

We have big news to announce: investors in pharmaceutical companies who together represent over €3.5 trillion in investment assets today support AllTrials. This group of 85 pension funds and asset managers are now to writing to the companies they invest in to ask them to set out plans to ensure their clinical trials, past, present and future, are registered and results reported.

Ben Goldacre described today’s investor action as game changing. For those who thought they could ignore AllTrials, those who thought they could ignore public calls for transparency, and those who thought no one was checking their compliance with the rules, it sends a clear message: Wake up!

AllTrials worked with BNP Paribas Investment Partners to run workshops with investors to develop the steps they are calling on companies to take. Read those steps here. Helena Vines Fiestas from BNP Paribas Investment Partners explains why investors want transparency: “Alongside doctors and their patients, investors also risk being misled … it is essential that companies publish complete and accurate information on trial results so that investment decisions can be fully informed.” That is why investors including Aviva Investors, Boston Commons Asset Management, RobecoSAM, 65 UK local authority pension funds and the investment arm of the Wellcome Trust are today writing to pharma companies asking them to be more transparent.

Read more about this in today’s Financial Times, the Economist tomorrow and at alltrials.net and please share this news far and wide.

Drug testing
Trials and errors
The evidence base for new medicines is flawed. Time to fix it
Jul 25th 2015 | From the print edition
•
•
•

WHEN patients are prescribed a drug, they might assume it had been subject to the closest scrutiny. They would be wrong. The results of about half of all clinical trials are never published. Companies are allowed to run many tests and publish only the ones with results they like. Unsurprisingly, negative results are far less likely to appear in public.
Regulators can see the results of every trial. But that provides only so much comfort. Officials may well be convinced that a particular drug has enough value for a few patients to pass the bar for approval, but that does not tell doctors whether the drug is better to prescribe than other treatments. And the regulators have limited resources. They cannot match the sort of scrutiny that comes from making all trial results public. Independent evaluations were important in raising concerns about the heart-attack risks associated with Vioxx, a painkiller that was recalled in 2004.
At best, this bias in published results has produced a polluted evidence base. Patients have been prescribed antidepressants that look much less effective when unpublished data are taken into account. The British government’s decision to stockpile antiviral drugs in case of a flu pandemic looks less clever now that previously unpublished data have called their efficacy into question. At worst, the skew has caused demonstrable harm. Some patients may have died because data about potentially dangerous side-effects were not published; volunteers in clinical trials may have suffered harm for no reason.
Legislators in America and Europe want the problem of missing trials fixed (see article). New legislation comes into force in Europe in 2016 that will require the registration of clinical trials and the prompt publication of results. The question is how tightly these rules will be enforced. America laid down similar requirements in 2007, but they have been more observed in the breach. That is not good enough. Everyone involved in clinical trials—regulators, drug firms and academics—has a compelling reason to do better.
Regulators first. America’s Food and Drug Administration has the power to fine companies that fail to report trial results within a year of their completion, but has not yet exercised it. Expected new rules should make this easier. The public interest in the registration and release of all trial results is clear. Compliance needs to be monitored and enforced.
Drug firms are bound to be leerier of releasing negative trial results. But the ground is shifting. Now that campaigners have brought the issue to public attention, there is real concern that patients will lose interest in taking part in trials if the data are never going to see the light of day. And investors are waking up to the financial risks inherent in incomplete publication of trial results. About 30% of a drug company’s valuation is based on results from its Phase-III trials (when drugs are extensively tested in humans). Investors are now urging the industry to disclose more data, both to ensure more accurate valuations and to lower the risk of future litigation.
If anything, academics have an even worse record of disclosure than firms. Those who pay for their research ought to weed out grant applicants who routinely fail to publish results.
Phase haze
Even if all new trials are registered and published, the problem remains of what to do about the evidence base for drugs already in use. There is no legal obligation on researchers to publish data from old trials, but there is a moral one. A patient who is taking the wrong drug for his cancer because of inadequate disclosure is being denied the opportunity to receive better treatment. That could not be more wrong.

Oh god it really does make me want to vomit. You could almost think Alltrials was the brainchild of Witty himself. It’s like a gift to GSK. The PR department at GSK must be rubbing their hands together with glee.

As David C jets off to Asia next week for another Trade Mission, I was looking around for a list of those accompanying him and just vaguely wondering if Mr Witty would be in attendance promoting his products such as Sensodynetoothpaste and Seroxathappypill; where’s a Chinawhys when you need one; he’s in Englandwhys……recuperating from his experience…. with GSKwhys…………..

And, a few lessons in worming, with a statin thrown in, and, a bit of Pluto, too; great oratory, Ben….brief, concise, well researched, eloquent and your usual ebullient self…fancy a go at Paroxetine?

There is a very irritating and disturbing trend for newscasters to announce various scientific statistics and “facts” about new discoveries that will transform our lives. They create a climate of expectation when the acclaimed benefits may not materialize for decades. Are we supposed to take it as our right to have permanent insulation against disease and death?
They are not so quick to explain how inadequate is the knowledge in the scheme of things and how little we know about the complex chemistry that makes up our nature.
This subversive demand of the public is based on the so called integrity of the news and the newscaster who put it across so convincingly. Why are they not questioned and analyzed and the statistics put into perspective?
They seem to pay scant regard for the fact that by treating our bodies with care and respect instead of focusing on some utopian pathway which is underlining our ignorance and reducing our ways of instinctive survival and commonsense. perhaps we don’t always need to to fix something that can be prevented from ever happening in the first place.
This traffic in dubious information and discoveries keeps people in jobs and insulating people from many facts that are staring everyone in the face. The complex web of insinuation and ignorance needs to be studied more seriously and not gloss over inadequate evidence.

A thoughtful article, David.
Having given up on the FDA’s pharmaceutical division, I looked into what it does with food and discovered the same toadying up to industry there.
Having mainly given up on medication (yes, I would take penicillin if need be; my daughter – having had spinal meningitis as an infant – was saved by ampicillin), I look to good food – organic whenever possible – as my medicine.
Living in California, I have access to farmers’ markets, an organic market nearby, and friends’ gardens for sustenance.
To further care for my body, I ride my bike, and swim.
I am not a goody two shoes, mind you – enjoying my wine and dark chocolate with the best of them.
But I did fight for Prop. 37, the right to know if GMOs were in my food – of course this went down to defeat thanks to the likes of Monsanto and BigFood.
Beyond BigPharma for a moment, large corporations, including chemical companies and so on, are bound and determined not to be fettered with any regulations, letting the buyer beware in all realms.
Seems to me that, somehow, this buyer-beware-dom has yet to filter into the brains of even the most thoughtful “consumers” in the realm of prescription drugs no matter how hard some of us have tried. Quick fixes are in the public brain, unfortunately, and the fact that deaths from prescription drugs, taken as prescribed, have side effects that are the number 3 cause of death in the United States has yet to enter the public consciousness. Quite astonishing, really.

The notion of moving back to ‘slow medicine’ is very appealing indeed, bearing in mind that “Golden Ages’ are very rarely as gilded as memory suggests (as Johanna has written powerfully in another comment). I’ve just read a contemporaneous account, by a nurse, of the horrors of a diphtheria ward in 1950: she could do nothing to cure the choking, agonising disease that killed a significant number of the children she was nursing. I give thanks that my kids were spared that risk – thanks to advances in medicine. And it made me think that possibly the memory of losing children to such diseases underpins the readiness with which the miraculous nature of medicines (chemicals) were embraced in the 1950s and 60s. And, possibly, if it had been possible to keep commerce and healing separate – then medicines might have developed differently. But that’s a big, unknown question.

To offset the ghastliness of the diphtheria ward I picked up ‘Ask the Fellows who Cut the Hay’ by George Ewart Evans. Written in 1960, it’s an early example of social history. He was trying to record farming methods, thousands of years old, just as they were being displaced by new technology: tractors and combine harvesters. He is simply making a record – and acknowledges the backbreaking drudgery and ill health caused by the old ways – but my eyes popped when I read the following:

…in spite of its advances farming is only partially scientific; it is still very much an art, depending to a large extent not so much on a body of generalised rules – the precepts of modern agricultural science – as on their application to a particular farm or district. Farming, in this respect, is like medicine: the modern doctor has his encyclopaedic knowledge, his drugs, his specifics, and his up-to-date equipment but in the last resort he cannot treat by rote; each patient has to be regarded not only according to the dictates of general practice concerning one disease or another, but just as much as an example of the disease’s particular and individual manifestation. In same way the farmer knows that his job does not entail simply the mechanical application of a set of textbook rules: each farm, each field, in fact, is different; and like a patient demands to be treated with sympathetic understanding born of long experience. ‘

That seems to perfectly encapsulate what has been lost in medicine; and particularly in the relationship between patient and doctor. It doesn’t look likely to return any time soon – particularly now the drug industry has already got its claws into the idea of ‘personalised’ treatment – like you, Johanna, the phrase makes me gag.